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J Mertin

Publications and source records attributed to J Mertin.

At least 19 recordsLinked to original sources
PubMed2005

A randomized, double-blind, placebo-controlled study of oral hydrolytic enzymes in relapsing multiple sclerosis.

Oral administration of hydrolytic enzymes (HE), such as bromelain, trypsin and rutosid, may have beneficial effects on the clinical course of neurological symptoms related to multiple sclerosis (MS). This is supported by a complete protection by HE from experimental allergic encephalomyelitis, an animal model related to MS. Three hundred and one patients with relapsing MS were enrolled in a double-blind, placebo-controlled trial. No treatment effect between the placebo and the HE groups was found either for clinical or MRI parameters.

Administration, Oral↗
PubMed2004

Escalating immunotherapy of multiple sclerosis--new aspects and practical application.

Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.

Clinical Trials as Topic↗
PubMed2004

The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke.

OBJECTIVE: To examine the clinimetric characteristics of the Trunk Impairment Scale (TIS). This newly developed scale evaluates motor impairment of the trunk after stroke. The TIS scores, on a range from 0 to 23, static and dynamic sitting balance as well as trunk co-ordination. It also aims to score the quality of trunk movement and to be a guide for treatment. DESIGN: Two physiotherapists observed each patient simultaneously, but scored independently. Each patient was re-examined by one of the therapists. SUBJECTS: Twenty-eight patients in a rehabilitation setting. RESULTS: Kappa and weighted kappa values for item per item reliability ranged for all but two, from 0.62 to 1. All percentages of agreement exceeded 81%. Intraclass correlations (ICC) for the summed scores of the different subscales were between 0.85 and 0.99. Test-retest and interobserver reliability for the TIS total score (ICC) was 0.96 and 0.99, respectively. The 95% limits of agreement for the test-retest and interexaminer measurement error were -2.90, 3.68 and -1.84, 1.84, respectively. Cronbach alpha coefficients for internal consistency ranged from 0.65 to 0.89. Content validity was defined. Spearman rank correlations with the Barthel Index (r = 0.86) and the Trunk Control Test (r = 0.83) was used to examine construct and concurrent validity, respectively. CONCLUSIONS: Analysis of different clinimetric parameters support the use of the TIS in both clinical use and future stroke research. Guidelines for treatment and level of quality of trunk activity can be derived from the assessment.

Abdomen↗
PubMed1991

Overview of azathioprine treatment in multiple sclerosis.

The efficacy of azathioprine in the treatment of multiple sclerosis was assessed by meta-analysis of the results of all published blind, randomised, controlled trials. 793 patients were enrolled in 5 double-blind and 2 single-blind studies. After 1 year of treatment, the increase in Kurtzke disability status score was no different in treated and control groups, but at 2 years there was a small difference (-0.22; 95% confidence interval [CI] -0.43, 0.003) in favour of azathioprine treatment; this difference was sustained, but not increased, after 3 years. The probability of freedom from any relapse during 1, 2, and 3 years' treatment was significantly greater in the azathioprine-treated group (relative odds over 3 years 1.97; 95% Cl 1.27, 3.04), but it is debatable whether the slight clinical benefits of azathioprine outweigh its side-effects.

Azathioprine↗
PubMed1991

[Rehabilitation in multiple sclerosis].

Rehabilitation is the only effective treatment in multiple sclerosis (MS), as long as the cause of this commonest neurological disease of younger adults is not known. No medical treatment constantly influences the course of the disease. Methods for restitution of functional impairments, for improvement of abilities and for adaptation of daily life according to constraints caused by disability and handicap are applied with the goal of enlarging personal free space. Inadequate prevention of complications is often the cause for apparent progressive deterioration of the disease. Efficient symptomatic therapies have helped to increase life expectancy and to improve quality of life of MS patients in recent years.

Humans↗
PubMed1989

Randomised double blind controlled trial of cyclosporin in multiple sclerosis.

In a 2 year double blind controlled trial of cyclosporin against placebo in multiple sclerosis conducted at two centres there was a beneficial effect of the therapy upon the progression of the disease, relapse rate and relapse severity at one of the centres where the patients received a mean dose of 7.2 mg/kg/day. This beneficial effect was not seen in the other centre where a lower dose (mean 5 mg/kg/day) was given. Reduction in clinical progression was accompanied by decreased IgG synthesis in the central nervous system. Side effects included hypertension, renal insufficiency and anaemia and were of such severity to preclude the use of cyclosporin in a high enough dose to alter the course of the disease.

Adolescent↗
PubMed1985

Nutrition and immunity: the immunoregulatory effect of n-6 essential fatty acids is mediated through prostaglandin E.

Suppression of cell-mediated immune responses by essential fatty acids (EFA) was demonstrated in mice maintained on a standard laboratory diet for rodents. Daily oral administration of EFA at doses ranging from 125 to 750 mg/kg body weight significantly suppressed local host-versus-graft and graft-versus-host reactions as measured by popliteal lymph node assay. Studies employing immune sera directed against E-type prostaglandin demonstrated that n-6 EFA-induced suppression was mediated through prostaglandin E1. In titration experiments the effect of n-6 EFA on the reactions was dose dependent with enhancement of the responses at low concentrations and suppression at high concentrations.

Alprostadil↗
PubMed1985

Modulation of the host-versus-graft reaction of the popliteal lymph node by small numbers of dendritic cells injected at a distant site.

This paper demonstrates that dendritic cells (DC) injected intraperitoneally into CBA mice can alter the popliteal lymph node response of the animals to semi-allogeneic spleen cells injected into the footpad. This effect is antigen specific, for both cell populations must share the same foreign antigenic determinants. The alteration is expressed as an augmentation of node swelling following injection of very low numbers of DC, whilst a slight increase in the numbers of DC leads to suppression of the host-versus-graft response. Therefore it would appear that, in addition to their role as antigen-presenting cells, DC are also capable of modulating the response to an allogeneic stimulus in an antigen-specific manner. It is postulated that such antigen-specific modulation arises from formation of complexes between prostaglandin E1 and antigen-presenting moieties, which then determine the direction of the immune response.

Animals↗
PubMed1984

A critical evaluation of the Incapacity Status Scale.

The Incapacity State Scale (ISS) of the research version of the Minimal Record of Disability in Multiple Sclerosis has been tested in parallel with Assessment of the Activities of Daily Living (ADL) Index. Reliance of the ISS scoring on the use of aids and adaptive devices was found to be a major source of variation. It is suggested that the general scoring of the proposed ISS scale should be modified so that it employs that of the ADL method, i.e. measuring only independence (irrespective of the use of side and adaptive devices), partial and total dependence.

Activities of Daily Living↗
PubMed1984

Prostaglandins and cell-mediated immunity. The role of prostaglandin E1 in the induction of host-versus-graft and graft-versus-host reactions in mice.

Based on studies in lymphocyte cultures it has been suggested that endogenous prostaglandins (PG), especially those of the E series (PGE), suppress cell-mediated immune reactions during their induction phase. We have tested this theory in experimental animals using local host-versus-graft (HVG) and graft-versus-host (GVH) reactions in mice. These reactions were suppressed in a dose-dependent manner by treatment of the animals with PGE1. If, however, endogenous PGE was neutralized through treatment of the animals with immune sera directed against PGE (APSE1) then inhibition of the development of HVG and GVH reactions was seen. This inhibition could be abrogated in "add back" experiments by treatment of the animals with PGE1. We suggest that the action of PGE1 during the induction phase of CMI responses is governed by a bell-shaped dose-response curve with a response-enhancing effect at low PGE1 and a suppressive effect at high PGE1 concentrations. APSE1 has proved to be very effective in inhibiting responses, and thus treatment with anti-PG antibodies may not only represent a valuable tool for the study of the role of PG in immunoregulation, but may become useful in therapeutic interventions with the immune system--e.g., after bone marrow transplantation.

Animals↗
PubMed1983

Induction of immune responses in vivo with small numbers of veiled (dendritic) cells.

The role of dendritic or veiled cells (VC) from lymph nodes or spleens of rats and mice in initiating immune responses in vivo has been investigated. Host-versus-graft responses were induced by injection of VC from spleens of (C57BL/10 X CBA) F1 mice into the footpads of parental strain (CBA) animals and measured by the increase in the weight of the draining popliteal lymph nodes. The potency of VC to induce the responses was 100-fold greater than that of unseparated spleen cells. The in vivo effect of VC was not limited to this direct allogeneic stimulation because autologous VC could also be used in the induction of an experimental autoimmune disease. In these studies, experimental allergic encephalomyelitis was produced in Lewis rats by injection of guinea pig brain and spinal cord material emulsified in Freund's complete adjuvant. Small numbers of VC from spleens or lymph nodes of rats showing clinical signs of experimental allergic encephalomyelitis induced a mild form of the disease when injected intravenously into normal Lewis rats. Thus, VC carrying antigen, either as an integral part of their surface membrane or acquired during exposure to antigenic substances, appeared to be very potent agents for the induction of immune responses.

Animals↗
PubMed1982

[Changes in lymphocytes caused by aldosterone and a spironolactone derivative. Animal experiments and clinical studies].

In animal experiments marked and characteristic changes of lymphocytes could be observed with electronmicroscopic methods due to aldosterone and potassium canrenoate. These results may be a further reference to an immunosuppressive effect of aldosterone and spirolactone derivates. The electronmicroscopic study of thoracic duct cells of a patient suffering from multiple sclerosis and treated with aldosterone and potassium canrenoate showed changes of the morphological structure of small lymphocytes, which was interpreted with a lymphoclastic effect of this substances on lymphocytes.

Adult↗